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The practice of circumcision, the procedure in which the foreskin of a male newborn’s penis is removed, has been stirring controversy for decades in the United States. Most recently, a California judge struck from the city ballots the proposal to ban circumcision of boys in San Francisco, stating it would infringe on religious freedom. The proposed measures would have made it illegal to "circumcise, excise, cut or mutilate the whole or any part of the foreskin, testicles or penis" of boys below age 18. Offenders — no matter their religion — would face a fine of up to $1,000 or up to one year in jail.

In 1999, the American Academy of Pediatrics issued a landmark policy statement recommending against the routine circumcision of boys. A new recommendation issued in May 2011, however, softens the group's stance, advising parents to consult with their pediatrician and consider their religious and cultural traditions when making a decision on circumcision surgery.

“They are now neutral on the issue,” says Marjorie Milici, MD, a pediatrician at Baylor Pediatric Center in Dallas. “They swing the pendulum back and forth every few years.”

Dr. Milici says she has seen a significant drop in routine circumcisions since she began practicing medicine 18 years ago. “When I first started practicing, almost everyone was getting it done,” she says. “Now it’s 50-50.”

Circumcision Surgery: Benefits and Risks

Research has shown that circumcision surgery can offer some health advantages. Boys with a circumcision penis are less likely to get urinary-tract infections and penile cancer, and they are also at decreased risk for acquiring the sexually transmitted diseases syphilis and HIV.These conditions may appear more frequently in uncircumcised men because of the additional effort that is required to keep the foreskin clean.

Conversely, Milici says, the risk of these diseases is very small in uncircumcised men who take good care of their foreskin so it should not be a major consideration when deciding whether to circumcise. “We’re reinforcing that to the bigger boys and parents bathing littler boys,” Milici says. “Once you can completely retract the foreskin, pull it back and clean in there every day.”

Many parents decide to forgo circumcision surgery because of the risks associated with the procedure, such as bleeding and infection. Pain is a consideration, too. Local anesthetics are usually given to the infants before the circumcision, but the days of healing that follow can cause soreness. One study has also shown that circumcised infants have a greater pain response to vaccinations later in life than their uncircumcised counterparts. “A lot of parents have read on that and don’t want that,” Milici says.

Some anti-circumcision advocates also claim that the procedure causes loss of sensitivity in the penis, decreasing sexual satisfaction. However, several studies have shown that circumcision has little effect on sensitivity.

And though some people associate circumcision with erectile dysfunction, there’s little evidence to back that up, Milici says. “Were those men going to get erectile dysfunction anyway, regardless of the circumcision?” she asks. “There’s no connection that I know of.”

Tradition can also be a factor in deciding whether to circumcise. Some people, such as those practicing Judaism, choose circumcision for religious reasons. Still others want their sons to have the procedure so they can look like other men in their family. “It can be sort of a rite of passage,” Milici says.

Circumcision Caveats

Medical conditions may make circumcision inadvisable. Parents should look at their newborn son’s penis carefully after birth to check for hypospadias, a rare condition in which the urethral opening is on the underside of the penis. Doctors will notice the abnormality most of the time, but it is occasionally missed. Boys who have the condition should not be circumcised. “A urologist will need that foreskin to elongate the urethra and put it in the proper place,” Milici says.

Circumcision is also inadvisable for boys with epispadias, an even rarer condition in which the urethra opens on the top of the penis.

Boys with hypospadias and epispadias often will look like they are “naturally circumcised,” with no foreskin. If parents notice this in their son, they should ask their pediatrician for a thorough examination before allowing circumcision.

When it comes to circumcision, parents should make the decision for themselves, Milici says, but she does not recommend it as a medically necessary procedure.

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